NSG 420 Care of a Patient with a Chest Tube

NSG 420: Care of a Patient with a Chest Tube

by Ginny Bayes

Multiple Choice

A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment, you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You also note a “sucking” sound when the patient inhales and exhales. The patient’s chest x-ray shows a pneumothorax. What type of pneumothorax is this known as?

• Closed pneumothorax

• Open pneumothorax

• Tension pneumothorax

• Spontaneous pneumothorax

Multiple Choice

In regards to the patient in the previous question, which of the following options below is a nursing intervention you would provide to this patient?

• Place the patient in the supine position

• Place a non-occlusive dressing over the chest wound and tape it on 3 sides

• Place an occlusive dressing over the chest wound and adhere it to the chest on three sides

• Prepare the patient for a thoracentesis

Multiple Choice

A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is NOT a correct statement about this type of pneumothorax?

• It can be caused by the rupture of a pulmonary bleb.

• It can occur in patients who are young, tall and thin without a history of lung disease.

• Smoking increases the chances of a patient developing a spontaneous pneumothorax.

• It is most likely to occur in patients with restrictive lung conditions that limit chest wall expansion

Multiple Choice

Which of the following is a LATE sign of the development of a tension pneumothorax?

• Hypotension

• Tachycardia

• Tracheal deviation

• Dyspnea

Multiple Select

While caring for a patient with a suspected pneumothorax, you note there are several areas on the patient’s skin that appear to be “bulging” out. These “bulging” areas are located on the patient’s neck, face, and abdomen. On palpation these areas feel “crunchy” to the touch. When charting your findings you would refer to this finding as? Select all that apply.

• Subcutaneous paresthesia

• Integumentary air trapping

• Subcutaneous emphysema

• Crepitus

Multiple Choice

You’re providing care to a patient with a pneumothorax who has a chest tube. On assessment of the chest tube system, you note there is no fluctuation of water in the water seal chamber as the patient inhales and exhales. You check the system for kinks and find none. What is your next nursing action?

• Continue monitoring the patient as this is a normal finding.

• Increase wall suction to the system until the water fluctuates in the water seal chamber.

• Assess patient’s lung sounds to assess if the affected lung has re-expanded.

• Notify the physician.

Multiple Select

A patient is receiving mechanical ventilation with PEEP. The patient has developed a tension pneumothorax. Select ALL the signs and symptoms that can present with this condition (SATA):

• Hypotension

• Jugular Venous Distention

• Tracheal deviation

• Hypertension

• Tachypnea

Multiple Choice

A patient receiving treatment for a pneumothorax calls on the call light to tell you something is wrong with their chest tube. When you arrive to the room you note that the drainage system has fallen on its side and there is a large crack in the system. What is your next PRIORITY?

• Place the patient in supine position and clamp the tubing.

• Notify the physician immediately.

• Disconnect the drainage system and get a new one.

• Obtain a new drainage system and only disconnect the chest tube right before you are ready to attach to the new system.

Multiple Choice

A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during your assessment requires immediate nursing intervention?

• The water seal chamber has intermittent bubbling.

• The patient has slight tracheal deviation to the right side.

• The water seal chamber fluctuates while the patient inhales and exhales.

• The patient complains of tenderness at the chest tube insertion site.

Multiple Choice

Which statement is CORRECT about a tension pneumothorax?

• This condition happens when an opening to the intrapleural space creates a two-way valve which causes pressure to build up in the space leading to shifting of the mediastinum.

• A tension pneumothorax is a medical emergency and is treated with needle decompression.

• Tracheal deviation is an early sign of a tension pneumothorax.

• An open pneumothorax is the only cause of a tension pneumothorax.

Multiple Choice

You are assessing a patient who just had a chest tube placed. On assessment, you note there is 50 mLs of serosanguinous fluid in the drainage chamber, fluctuation of water in the water seal chamber when the patient breathes in and out, and bubbling in the suction control chamber. Which of the following is the most appropriate nursing intervention to perform next?

• Document the findings in the EHR.

• Assess for an air leak due to bubbling noted in the suction chamber.

• Notify the physician about the drainage.

• Milk the tubing to ensure patency of the drainage tube.

Multiple Choice

You are providing care to a patient with a chest tube. On assessment of the drainage system, you note continuous bubbling in the water seal chamber and oscillation. Which of the following is the CORRECT nursing intervention for this type of finding?

• Reposition the patient because the tubing is kinked.

• Continue to monitor the drainage system.

• Increase the suction to the drainage system until the bubbling stops.

• Check the drainage system for an air leak.

Multiple Choice

A patient is recovering from a pneumothorax and has a chest tube in place.

Which of the following is an appropriate finding when assessing the chest tube drainage system?

• Intermittent bubbling may be noted in the water seal chamber.

• 200 mLs of drainage per hour is expected during recovery of a pneumothorax.

• It is positioned at the patient’s chest level to facilitate drainage.

• All of these options are appropriate findings.

Multiple Select

A patient is about to have their chest tube removed by the physician. As the nurse assisting with the removal, which of the following actions will you perform?

Select all that apply:

• Educate the patient that they will need to take a deep breath in rapidly during removal then breathe out slowly.

• Gather appropriate supplies including 4x4s, petroleum gauze and tape

• Place the patient in Semi-Fowler’s position.

• Have the patient take a deep breath, exhale then bear down during removal of the tube

• Place the patient in the prone position after removal.

Multiple Choice

BONUS question: What is your interpretation of this chest radiograph? 

• Right-sided open pneumothorax

• Left-sided simple pneumothorax

• Left-sided tension pneumothorax

• Right-sided tension pneumothorax